Provider Demographics
NPI:1255725917
Name:OLIVER, TIFFANY W (CRNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:W
Last Name:OLIVER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1509 DULLES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3718
Mailing Address - Country:US
Mailing Address - Phone:337-991-9276
Mailing Address - Fax:337-943-0846
Practice Address - Street 1:2201 N AIRPORT RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-7058
Practice Address - Country:US
Practice Address - Phone:205-221-9351
Practice Address - Fax:205-221-3700
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1136718363L00000X
AL1-136718363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner